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  • Age: 52
  • Sex: female
  • Medical history: Pain in the lumbar spine and in the left buttock - local infiltration with steroids (3x) by local physician. Afterward worsening of pain, fever. Hospitalisation because of an abscess of the left buttock area (S. aureus). Surgical drainage was performed and antimicrobial therapy was initiated. Back pain and deep buttock pain persisted. HLA-B27-negative, no definite inflammatory pain, no morning stiffness. Elevated CRP 20 mg/l.
  • Clinical findings: Tender left sacroiliac joint. Pain gets worse with excercise.

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Case 1: Buttock pain on the left

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Septic sacroiliitis

The key to the diagnosis of septic sacroiliitis is the gross destruction of the joint surfaces of the left sacroiliac joint. Osteitis is very pronounced, there is enhancement of paramagnetic contrast medium and pus in the joint space and the autochthonous musculature of the back is also affected.